Access at issue in abortion bill

Sept. 9, 2013

Updated Sept. 10, 2013 10:14 p.m.

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A man jogs by a Planned Parenthood building in Orange on Monday. One of the central questions in an abortion debate that has reached the governor's desk is this: How many abortion providers are there in California today? MINDY SCHAUER, ORANGE COUNTY REGISTER

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State Sen. Hannah-Beth Jackson, D-Santa Barbara, urged lawmakers to approve a measure to allow nurse practitioners, certified nurse midwives and physician assistants to perform abortions in the first trimester, at the Capitol last month. RICH PEDRONCELLI, AP

A man jogs by a Planned Parenthood building in Orange on Monday. One of the central questions in an abortion debate that has reached the governor's desk is this: How many abortion providers are there in California today? MINDY SCHAUER, ORANGE COUNTY REGISTER

By the numbers

522 – California abortion providers

52% -- Counties with no abortion provider (as cited by bill sponsors)

22% -- Actual number of counties with no abortion provider

One of the central questions in an abortion debate that has reached the governor's desk is this: How many abortion providers are there in California today?

That statistic is not as simple as it seems.

Proponents relied on a debatable figure provided by a pro-choice group while they argued for legislation allowing trained nurses and others to perform abortions. The bill passed the Senate and Assembly. Along the way, some questioned the fundamental assertion that more than half of California's counties do not have an “accessible” abortion provider.

This figure – 52 percent of counties without such a facility – is typically the basis for arguing poor and rural women have unequal access to reproductive health and that therefore that the law should be changed. In fact, a closer look at the numbers suggests that many more women have access to nearby abortion providers.

“It's a pretty complicated picture that has unfortunately been reduced to a few talking points,” said Tracy Weitz, a reproductive health researcher at UC San Francisco and lead author of a pilot study underpinning AB154.

Passed by wide margins in both houses of the Legislature, the bill would allow nurse practitioners, certified midwives and physician assistants to perform first-trimester surgical abortions. They would have to first undergo training. Today, these clinicians can only administer medications to induce abortion, while doctors can perform all procedures, including abortions in the first or second trimester of pregnancy.

Rural women sometimes have to travel long distances to find a doctor, proponents of the bill say, and waiting can lead to more expensive and risky later-term abortions.

The bill “provides greater access to women, particularly those who are living in rural communities,” added Sen. Noreen Evans, D-Santa Rosa.

But what does “accessible” mean?

The answer – at least as provided by supporters – is based on data from a nonprofit founded by Planned Parenthood, one of the bill's main sponsors.

The Guttmacher Institute conducted a survey of abortion providers, and it draws the “accessible” line here: facilities that perform 400 or more abortions per year. In California, there were 95 of these providers in 2008, the most recent year available, leaving 52 percent of counties without one. Supporters of AB154 have made the same distinction.

Rachel Jones, a senior research associate at Guttmacher, says the 400-abortion thresholdis intended to exclude hospitals – which often allow abortions only for certain medical reasons such as expected birth defects – and physician's offices, which are more expensive than clinics and not an obvious choice for manywomen.

“Hospitals and physicians may not be advertising the service,” Jones said in an interview last week, “while clinics are relatively easy for women to find.”

But that 400-or-more cutoff also excludes some low-volume clinics, which Jones acknowledges could simply be in less populated areas with less demand.

Some of the bill's opponents have questioned the assertion that rural areas have barriers to care.

“I represent 11 counties – probably three-quarters of them are rural – and there is not an issue in terms of access to doctors,” testified Sen. Ted Gaines, R-Rocklin.

One of the few resources for nationwide statistics on abortion providers, the Guttmacher Institute was founded by Planned Parenthood.

On its website, Guttmacher paints a much less desperate picture: 22 percent of California counties lacked an abortion provider, when counting hospitals and physician's offices. That compared with 87 percent nationally.

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